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Monday, June 27, 2011

On the occasion of 6th Annual World Elder Abuse Awareness Day (WEAAD) 15th June 2011 Silver Inning Foundation(SIF) a NGO working with senior citizens and their family members in association with INPEA (International Network for Prevention of Elder Abuse) Indian Chapter through Development, Welfare and Research Foundation (DWARF) and 'Little Things Matter Initiatives' (LTMI), SSS Global, FESCOM (Mumbai), ‘1298’ Senior Citizens Helpline, Mumbai, AISCCON , Harmony for Silvers Foundation & ALFRESCO FC commemorated Elder Abuse Awareness Day from on May 20th to June 20th 2011 . SIF through its networking and social media had taken the initiative to host various events pan India to create awareness and sensitize the Government and the Civil Society to eliminate/prevent elder abuse at both micro and macro level.

India is gradually undergoing a demographic change. With decline in fertility and mortality rates accompanied by an improvement in child survival and increased life expectancy, a significant feature of demographic change is the progressive increase in the number of elderly persons.The disintegration of the joint family system and the emergence of nuclear families, has affected the care of the aged the most, Elderly today are the most ignored and neglected segment.

World over 15th June is marked as World Elder Abuse Awareness Day by INPEA.INPEA is an organization, founded in 1997, which is dedicated to the global dissemination of information as part of its commitment to the world-wide prevention of the abuse of older people. The United Nations International Plan of Action adopted by all countries in Madrid, April 2002, clearly recognizes the importance of addressing and preventing abuse and neglect of older adults and puts it in the framework of the Universal Human Rights. INPEA is dedicated to supporting the plan of action.

World Elder Abuse Awareness Day month long programme aims to increase society's ability, through various programmes, to recognize and respond to the mistreatment of older people in whatever setting it occurs, so that the latter years of life will be free from abuse, neglect and exploitation. Objective for WEAAD 2011: • To create awareness in elderly people themselves regarding what comes under elder abuse. • To sensitize young people regarding elder abuse and to bridge the intergenerational gap between elderly and young people. • To create awareness in media and civil society at large regarding elder abuse.

Through this Online Elder Abuse Survey, we could find out the awareness about Elder Abuse, Magnitude & Intervention.

This survey was jointly conducted by Silver Inning Foundation(SIF) and Society for Serving Seniors (SSS Global) to assess Elder Abuse, Magnitude & Intervention from 20th May to 20th June 2011. It was hosted on the Survey Site www.questionpro.com at the link: http://elderabusemagnitudeandinterventionsurvey2011.questionpro.com/

The questionnaire was open for all Age group and was online for about a month. Wide publicity was given to this survey in a large number of web groups, blogs, websites and by email to Senior Citizens associations, Federations etc.

A total of 650 persons viewed the Questionnaire; however only 355 ventured to answer. Results below indicate the verdict of remaining 355 persons across India, no one dropped out after taking the survey. Results are given in Four sections and followed by Detail Report.

Summary Report

Section A

Question 1What is your Age: 23.73% in Age group of 45 yrs to 59 Yrs & 22.88% in Age Group of 70 yrs to 79yrs Question 2What is your Gender: Male 57.98%

Question 3What is your Marital Status: Married 58.97%

Question 4What is your Living arrangement: Living with Spouse 45.76%

Question 5Have you ever been a victim of elder abuse or neglect or you know someone who’s is victim of Elder Abuse or neglect: YES 57.26%

Question 6If Yes then what types of elder abuse and neglect you have encountered: Neglect 25.74%

Question 7Have you seen /Heard of Elder Abuse Case: Seen yourself 44.33%

Question 8 Who do you think are the Abuser: Son 32.76%

Question 10Elder abuse is an important issue and it’s there in our society: Strongly Agree 70.54%

Question 11How can you improve the situation of Elder Abuse/Victim, Intervention: General Awareness 19.04%

How can you improve the situation of Elder Abuse/Victim, Intervention? (Others)1. There must be alternative for the elders. If family is abusive, there needs to be a safe place to move to.2. More community coalitions working to stop/prevent elder abuse3. Adopt a senior citizen from your own family4. Counselling and proper action by local Association of Senior Citizens.5. Find reason for abuse and rectify 6. Sr. Citizens need to be educated to change with times, not to be rigid & interfering. Instead they should lend a helping hand to children.7. State sponsered elder homes8. Educating children about importance of grand parents9. Social security systems10. Support group and educating the elders about being non interfering in children's lives.11. Non corrupt execution12. Elders should be aware of types of Abuses and prevention should be point basis.13. Registration of all senior citizens and their follow up....

We Thank all the Senior Citizens and organization working for elderly for their participation and success of this Online Elder Abuse, Magnitude & Intervention. We are confident this report will help civil society and government to address the issues of Elder Abuse.

The survey report was compiled Sailesh Mishra, Founder President Silver Inning Foundation , NGO working with Elderly in India.http://www.blogger.com/img/blank.gif

About Society for Serving Seniors (SSS):SSS host world most active online senior citizens group: SSS Global. It is a society set up to take up the cause of the Senior Citizens Community as a whole. We believe that seniors should take care of themselves as far as possible and lead an independent life with dignity and respect. They must take responsibility for themselves for the sake of their own happiness. Fully responsible seniors not only take complete care of themselves but also reach out, not only to their families in a non-interfering manner but also to the society at large. This they do so by giving back to society what society has given them all along.

About Silver Inning Foundation (SIF):SIF is Not For Profit organisation and is part of Social Enterprise Silver Innings which hosts one of the most comprehensive and dedicated website for elderly &their family www.silverinnigs.com . The vision, mission and goals of SIF are centered on creating and implementing services and programmes that are holistic in nahttp://www.blogger.com/img/blank.gifture and address the need to acknowledge the much needed supportive environment that the elderly deserve. It looks at reintegrating the elderly into mainstream society and lives with dignity. Silver Innings is working towards creating Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.

Saturday, June 25, 2011

Alzheimer's Disease in India through the Blog choose to develop its action in spreading information on Alzheimer's Disease and related disorders in India in the aim to raise awareness and bring information and guidance to Indian families. The LinkedIn group is open to trained professional caregivers but also to family caregivers having enough experience with older people affected to share it in the aim to dialogue, learn and give tips. The Facebook page is totally open to dialogue and comments on the links.

People wishing to help and participate to the various actions of NGOs would be directed as potential volunteers to Silver Inning Foundation based in Mumbai or ARDSI or Helpage India.Alzheimer's Disease in India is now also on Karmayog forum for the same purposes : go to group directory section: http://www.karmayog.in/groups/content/alzheimers-disease-india-0

As we just started, the groups are gathering few members from India and the USA mostly. I'd like to gather more people to make it more efficient. We all know someone who knows someone who is a specialist or who's taking/taken care of a patient in his/her family. I'd like them to know that there is a place where they can find information and support free of charge or on professional basis and in a elder friendly way.

If you know someone knowing people concerned by this issue, you may direct them to these groups.Senior Citizens , Old Age Homes , Government , NGO's , Researchers and any one concern with Elders & Dementia/Alzheimer's can contact me.

Thursday, June 23, 2011

The present report, which is submitted in response to Economic and Social Council resolution 2010/14, gives an overview of the modalities of the first review and appraisal of the Madrid International Plan of Action on Ageing, 2002, that will be used for the second review and appraisal, as well as a preliminary indication of the United Nations system and civil society plans. The report also highlights lessons learned and issues which need more attention in the second appraisal exercise.

Introduction

1. The Madrid International Plan of Action on Ageing, 2002, adopted by the Second World Assembly on Ageing, stated that systematic review of its implementation by Member States was essential for achieving improved quality of life of older persons and that the Commission for Social Development should be responsible for the follow-up and appraisal of its implementation.

2. The present report has been prepared to facilitate discussions concerning the organization of the second review and appraisal of the Madrid Plan of Action at the Commission for Social Development, as requested in Economic and Social Council resolution 2010/14. Issues identified in resolution 2010/14, which relate to recent efforts by Member States and the United Nations system to participate in the implementation of the Madrid Plan of Action, are addressed in the report of the Secretary-General entitled “Follow-up to the Second World Assembly on Ageing”,submitted to the General Assembly at its sixty-fifth session (A/65/158).

3. While the principal approach to the review and appraisal of the Madrid Plan of Action has been defined in resolutions 42/1, 44/1 and 45/1 of the Commission for Social Development, further details are required on the modalities of the second review and appraisal cycle. Consequently, this report presents Member States with possible arrangements and a timeline. It also raises issues to be brought to the attention of Member States, taking into account lessons learned during the first review and appraisal process. Furthermore, the report outlines the initial plans of the United Nations system and civil society organizations in support of the review and appraisal process.

4. The modalities of the first review and appraisal exercise are summarized in the following section.

Process and modalities of the first review and appraisal of the Madrid International Plan of Action on Ageing, 2002,and their continuing relevance for the second review and appraisal exercise

5. In its resolution 42/1 on the modalities for the review and appraisal of the Madrid Plan of Action, the Commission for Social Development encouraged Member States to establish or strengthen national coordinating bodies or mechanisms to facilitate the implementation and dissemination of information about the Madrid Plan of Action, including its review and appraisal. The Commission also encouraged Member States to include both ageing-specific policies and ageing mainstreaming efforts in their review and appraisal of the Madrid Plan of Action and in their national strategies, bearing in mind the importance of mainstreaming the issue of ageing into global agendas.

6. In the same resolution, the Commission decided to undertake a review and appraisal of the Madrid Plan of Action every five years. Additionally, the regional commissions were requested to promote and facilitate the implementation, review,

Proposed calendar for the second review and appraisal of the Madrid Plan of Action

39. A step-by-step calendar of planned events, starting in 2011 at the national andregional levels and leading up to the global segment at the fifty-first session of the Commission for Social Development in 2013, is a helpful tool for Member Stateswhile organizing the second review and appraisal of the Madrid Plan of Action.

40. The participatory review and appraisal process was conceived as an ongoing national evaluation process that would also report to regional and global levels.While the review and appraisal exercise is not time-bound, it is important to set the target year for consolidating the findings at the global level. The target year of 2012 is important as it will mark the tenth anniversary of the Second World Assembly on Ageing convened in Madrid and, since there has not been a regional or a global review on ageing since 2007, it will also close a five-year gap in assessing the situation of the world’s older persons and international action on ageing.

41. At the same time, however, a great deal of preparatory work remains to be done, at all levels, to make the bottom-up participatory review and appraisal more meaningful and successful compared to the first review and appraisal of the Madrid Plan. Therefore, a series of activities is proposed in the calendar that follows, highlighted by a global review and appraisal of the implementation of the Madrid Plan of Action during the fifty-first session of the Commission for Social Development in 2013. The tentative calendar for the second cycle of the global review and appraisal of the Madrid Plan of Action is set out below.

201142. As a first step, Member States would identify specific areas for in-depth participatory inquiries using the bottom-up approach and collect information about the actions they have taken since the first review and appraisal, such as new laws, policies and programmes, the establishment of coordinating mechanisms and information campaigns.

43. Information on the initial experience and good practices in organizing and conducting bottom-up participatory evaluation at the local and national levels will also be collected, analysed and presented later to the regional commissions. Upon request, the regional commissions, in cooperation with other entities, will assist countries in conducting their national review and appraisals and encourage participatory approaches to the process.

201244. Regional processes of review and appraisal will begin. Regional commissions will convene regional conferences in early to mid-2012, subject to the availability of sufficient financial resources, to consider the findings of national reviews, share experiences and good practices and identify priorities for future action. The regional commissions will submit the conclusions of the meetings and individual national reports to the Commission for Social Development in 2013.

201345. The Commission for Social Development, at its fifty-first session in February 2013, will conduct the global segment of the second cycle of review and appraisal of the Madrid Plan of Action. The modalities of this segment could include a series of plenary meetings, deliberations or a series of round tables. This would provide opportunities for assessing progress in the implementation of the Madrid Plan of Action at the national and regional levels, identifying achievements and obstacles in the implementation process, exchanging experiences and good practices, analyzing international cooperation on ageing and selecting priorities for the next cycle of the implementation process. Participants could include representatives of Member States, United Nations system organizations and representatives of civil society. An outcome document would include the conclusions of the second review and appraisal exercise along with the identification of prevalent and emerging issues and related policy options. Member States may wish to consider these and other options before making a final decision on the final format of the global segment for 2013.

This report, which is issued pursuant to General Assembly resolution 64/184, presents information on progress made in achieving the Millennium Development Goals through a comprehensive review of successes, best practices and lessons learned, obstacles and gaps, and challenges and opportunities, leading to concrete strategies for action. It consists of four main sections. The introduction examines the importance of the Millennium Declaration and how it drives the United Nations development agenda. The second section reviews progress on achieving the Millennium Development Goals, presenting both shortfalls and successes in the global effort and outlines emerging issues. The third section sums up lessons learned to shape new efforts for accelerating progress to meet the Goals and identifies key success factors. The fourth and final section lists specific recommendations for action. The report calls for a new pact to accelerate progress in achieving the Goals in the coming years among all stakeholders, in a commitment towards equitable and sustainable development for all.

I. Introduction

1. The adoption of the Millennium Declaration1 in 2000 by 189 States Members of the United Nations, 147 of which were represented by their Head of State, was a defining moment for global cooperation in the twenty-first century. The Declaration captured previously agreed goals on international development, and gave birth to a set of concrete and measurable development objectives known as the Millennium Development Goals. Spurred by the Declaration, leaders from both developed and developing countries committed to achieve these interwoven goals by 2015.

2. The Millennium Development Goals are the highest profile articulation of the internationally agreed development goals associated with the United Nations development agenda, representing the culmination of numerous important United Nations summits held during the previous decade, including summits on sustainable development, education, children, food, women, population and social development. They are the world’s quantified, time-bound targets for addressing extreme poverty, hunger and disease, and for promoting gender equality, education and environmental sustainability. They are also an expression of basic human rights: the rights of everyone to good health, education and shelter. The eighth Goal, to build a global partnership for development, includes commitments in the areas of developmentassistance, debt relief, trade and access to technologies.

3. During the past decade, the Millennium Declaration and the Millennium Development Goals have led to unprecedented commitments and partnerships reaffirmed in successive summits and meetings, including the 2002 International Conference on Financing for Development at Monterrey, Mexico, the 2002 World Summit on Sustainable Development, in Johannesburg, South Africa, and the 2005 World Summit in New York. During this same period, the public and their Governments have also had to contend with new unanticipated challenges. Some have been specific to countries or regions, while others have been global, such as the food and economic crises of the last three years.

4. Our challenge today is to agree on an action agenda to achieve the Millennium Development Goals. With five years to go to the target date of 2015, the prospect of falling short of achieving the Goals because of a lack of commitment is very real. This would be an unacceptable failure from both the moral and the practical standpoint. If we fail, the dangers in the world — instability, violence, epidemic diseases, environmental degradation, runaway population growth — will all be multiplied.

5. Achievement of the Millennium Development Goals remains feasible with adequate commitment, policies, resources and effort. The Millennium Declaration represents the most important collective promise ever made to the world’s most vulnerable people. This promise is not based on pity or charity, but on solidarity, justice and the recognition that we are increasingly dependent on one another for our shared prosperity and security.

6. The Millennium Development Goals provide a historic framework for focus and accountability. This fabric of accountability, however, is being tested and will need to be further strengthened to achieve the Goals by 2015. This is all the more important as the Goals are crucial stepping stones towards equitable and sustainable development for all. Meanwhile, the devastating impact of climate change looms large, and the international community is facing the challenge of working together to ensure the end of extreme poverty and sustainable development to save the planet and its people, especially the most vulnerable.

7. This report calls on all stakeholders, including national Governments, donor and other supportive Governments, the business community and civil society at large, to work in concert to ensure that the Millennium Development Goals are met by 2015. The high-level plenary meeting of the General Assembly to review the implementation of the Goals in September 2010 will provide a unique opportunity to strengthen collective efforts and partnerships for the push to 2015. The present report assesses achievements and shortfalls thus far, and suggests an action agenda for the period from 2011 to 2015.

II. Progress so far

8. A number of countries have achieved major successes in combating extreme poverty and hunger, improving school enrolment and child health, expanding access to clean water and access to HIV treatment and controlling malaria, tuberculosis and neglected tropical diseases. This has happened in some of the poorest countries, demonstrating that the Millennium Development Goals are indeed achievable with the right policies, adequate levels of investment, and international support. Considering their historical experience, some poor countries and even whole regions have made remarkable progress. For example, sub-Saharan Africa has made huge improvements in child health and in primary school enrolment over the past two decades. Between 1999 and 2004, sub-Saharan Africa achieved one of the largest ever reductions in deaths from measles worldwide.

9. Nevertheless, progress has been uneven and, without additional efforts, several of the Millennium Development Goals are likely to be missed in many countries. The challenges are most severe in the least developed countries, landlocked developing countries, some small island developing States and countries that are vulnerable to natural hazards and recurring lapses into armed violence. Countries in or emerging from conflict are more likely to be poor and face greater constraints, because basic infrastructure, institutions and adequate human resources are often absent and lack of security hampers economic development.

10. Later this year, the Millennium Development Goals Report 2010 and MDG Gap Task Force report will assess progress on achieving the Goals. The latest update of the 60 official Millennium Development Goal indicators will be presented in an addendum to the present report, to be issued later this spring. The following section of the report assesses successes, obstacles and gaps in order to draw lessons on actions needed to achieve the Goals.

Wednesday, June 22, 2011

“Alzheimer’s is not a sprint. It’s a marathon.” This was what the memory care center manager told us during our first care conference. It took a while for this to sink in fully. She was encouraging our family to find a balance between caring for our loved one who has Alzheimer’s and still maintaining a life for ourselves. A sprinter focuses on speed for a short distance but soon runs out of strength. Just as a marathon runner trains for endurance, an Alzheimer’s caregiver must approach this disease with the long run in mind.

When we first became responsible for an aunt with Alzheimer’s, our lives drastically changed. It often felt as if our lives were spinning out of control. There was little time for anything or anyone other than Aunt Betty. We finally realized that it would be impossible to continue at the same pace. If we failed to take care of ourselves, we might not be able to continue caring for her. Alzheimer’s can be a long, slow process. It is essential that Alzheimer’s caregivers take care of themselves, too.

An often-neglected area for us has been diet and exercise. Weight control has always been a losing battle in our family. Unfortunately, our first response to stress is to eat. The result has been not only weight gain, but increased cholesterol levels. A poor diet leaves you feeling tired and sluggish. Exercise is not an option when you feel so exhausted. That further complicates the health risks. A healthy diet and exercise will help a caregiver finish the marathon called Alzheimer’s disease.

Another area we’ve struggled with involves relaxation time. In order to adequately tend to Aunt Betty’s needs, we have to allow ourselves time away from the demands of Alzheimer’s care. Time away should not be accompanied with guilt. Ask other family members or friends to take your place as caregiver to allow you some time for yourself. Sometimes time away may be only a few minutes.

Mood swings and aggression are typical for the person suffering from Alzheimer’s. Trying to deal with these moods can be exhausting, too. In the beginning of our journey with my aunt’s illness, we tried to reason with her when she became irritable. Sometimes she said very hurtful things to us. Learning to walk away during those episodes was a huge step toward maintaining our sanity and well-being. It’s necessary to do that sometimes.

Remember that people with Alzheimer’s may have already lost the ability to reason. Attempting to reason with them may create more frustration for both of you. Your health may depend on walking away for a few minutes, too.

Find Alzheimer’s help in support groups whenever possible. The advantage of such a group is that you can learn from the experiences of others who are further along in the journey. You can learn what to expect and get advice on how to face the challenges ahead. We’ve learned so many things by trial and error. If we’d been involved in an Alzheimer’s support group, we might have found the road a little less bumpy.

Alzheimer’s support groups are usually available at churches, community centers, facilities specializing in memory care, and nursing homes. Check your local yellow pages for groups in your area. If you’re not comfortable in a group setting, you can contact counselor or NGO/ARDSI/Silver Inning Foundation could prove helpful.

Finally, make it a priority to have relationships with others who have no connection with Alzheimer’s. Everything in your life does not have to be about the disease. For your own mental, physical, and emotional health, develop friendships with people who can provide an escape.

Tuesday, June 21, 2011

Dementia is a progressive brain dysfunction which results in memory loss and a restriction of daily activities and in most cases leads in the long term to the need for care. Dementia is one of the major causes of disability in late-life. Many diseases can result in dementia, the most common one being Alzheimer's disease. It mainly affects older people ; about 2% of cases start at the age of 60 years. After this, the prevalence doubles every five years. Dementia affects each person and family differently. As dementia progress, there are notable changes in memory, thinking, language, behavior and function — all of which require different skills and strategies. Very few of us have a natural born knack for care giving. The challenge posed by dementia as a health and social issue is of a scale we can no longer ignore. Despite the magnitude, there is gross ignorance, neglect and scarce services for people with dementia and their families. This Presentation is prepared by Silver Inning Foundation in association with ARDSI Greater Mumbai Chapter for Information and awareness. June 2011 . Contact : silverinnings@gmail.com . Website: www.silverinnings.com

Friday, June 10, 2011

India is big, crowded, and changing faster economically and socially than it can seem to keep up with. The largest democracy in the world with over one billion people, it is completely overwhelming and exhilarating, but there is also a prevalent warmth and hospitality within the people wherever you go. India’s history is as rich and colorful as you can get, with hundreds of different conquerors and border changes, the famous story of independence led by Mahatma Gandhi, and evidence of it all remaining in the temples, statues, and preservations of countless historical sites. The culture is heavily influenced by religion and their daily rituals influence almost every part of the lives of the Hindu people I interacted with. Muslims and Christians, along with Sikhs, Buddhists, Jains, Jews, and Zorastrians also are seen openly practicing their religions, and all living in relative peace and sybiosis with each other.

The changes that the country is experiencing are palpable. A brand new office building next to a rusty corrugated metal capped slum in Mumbai, a polished SUV on the road next too a cow, and of course the technology boom bringing western modernity into the developing world that is trying to keep up, are some of the obvious sites showcasing the new vs. the old. Health issues are changing too- there is improvement in some public health measures, but there is still a long way to go; you’d be very adventurous to drink the tap water. And with the large amount of people moving into the cities and greater availability of unhealthy foods, rates of diabetes and hypertension are on a dangerous incline. But when talking to the locals about what is changing, especially from the elderly generation, you hear about the huge social changes taking place. The breakdown of the Indian family model, which used to be comprised of a large household with all generations, is now becoming nuclear and leaving many from the silver generation without a home.

My rotation focused on the health and social issues of the elderly population in India. I worked with a multi-faceted medical NGO in Bangalore, The Nightingale Trust, whose realm includes home medical care, an inpatient dementia care unit, adult day care, and rural medical visits amongst other things. I also worked with a newer NGO in Mumbai known as Silver Inning Foundation which uses social networking and media to help address multiple human rights issues and needs of the elderly. My goals in this rotation were to learn about the health and human rights issues involving the elderly in India and compare them to the USA’s, share my knowledge and ideas with the Indian people I work with, and use my connections and what I learned in the future in some way to help address these and similar problems.

Before leaving, I had some grasp on the issues affecting the elderly. I had heard that there were rising amounts of elderly people due to increasing life expectancy, and little infrastructure to support them. Also I knew rates of diabetes were on the rise. I wanted to explore the issues from a medical and human rights perspective, as are my interests. When arriving, I found that these things were true, and more. Again and again I heard the stories of children abandoning their parents, or moving away to the US. There was no government support to help them finance their daily life. Rates of depression have increased in the elderly as an outcome of the changing family structure too.

The NGOs I worked with were helping to address these issues. Nightingale Trust was providing home care to people in the cities and the rural areas that once had no access. They also help underfunded people with adult daycare, abuse help lines, and sliding scale payments. Silver Inning foundation was using social networking and media to connect elderly people with each other and with the help they needed. They put poor people in touch with affordable old age homes, provided an elder abuse hotline, visited men’s and women’s group and provided them with information and ideas, and were constantly promoting awareness with innovative networking. I was a part of these NGOs as an observer and short-term worker. I think my presence benefitted the people I interacted with by sharing my knowledge of how the elderly are treated in America and by showing my support of the activities and the people in need.

I think the greatest benefit of students’ involvement in global health is the impact is has on the student herself. I would not be the person or doctor that I am if it wasn’t for my community service and global health experiences. My experience in India humbled me and took my breath away several times. The family that I stayed with told me that instead of selling their printing company, they just gave it to their employers as a sign of gratitude for years of hard work. Both NGOs I worked with were started by individuals who used all self-funding for years to keep them alive. The fact that everything seems to work out so well in the face of so much constant chaos in India, I can only attribute to the amazing way everyone is constantly helping their fellow man. As my rotation had a large focus on human rights, I think this observation of hospitality, selflessness, and charity made the largest impression on me.

In terms of my professional career, experiences like this rotation benefit me greatly. I am entering into a residency in Internal Medicine that focuses on helping a diverse and underserved population, and the more experience I get with other cultures and pathologies, the better I can treat each individual. It also shapes my goals and reiterates my desires to help all people, regardless of class, race, and borders. I will be more of an advocate for the elderly after interviewing and assisting so many in India. And I will be much more mindful of human rights issues with the elderly such as abuse, lack of support and a home, depression and loneliness. Also, I made a lot of connections with doctors and activists in India, and I have no doubts that we can continue to work together in the future.

In my time in India I worked in two large cities, visited rural sites surrounding them both, and traveled to 5 cities total. I aimed to get as much possible out of my short time there and I think I succeeded. The NGOs I worked with showed me a comprehensive view of the health and human rights issues affecting the elderly in India. Most of the medical problems were similar to what we see here. Diabetes is on the rise, mostly due to the influx of people into urban areas, and the availability of food, unhealthy food, in the cities. Also with urbanization come many sedentary jobs leading to lack of exercise and obesity. Other common things are common, such as hypertension, asthma, COPD, dementia, depression, and cancer. Dementia is receiving growing attention, and the prevalence is increasing due to the increase in life expectancy and increase in awareness.

When I explored the Indian people’s perception of health care in their country I was surprised at how little people complained, which was much less than I feel we do here in America. I found myself looking for problems, asking leading questions to get to the bottom of it. What I found is that most people say they get medical care when they need it, and at not too high of a cost. Very few people have insurance, and there is no Medicaid or Medicare equivalent for the destitute and elderly. However with the lower cost of health care due partly to the lack of insurance companies, most people get what they need. I asked, “What if you get cancer? What if you have diabetes? What if you’re the poorest poor?” Most of the responses were basically that if you have chronic diseases there are schemes available to help, and that there are good government hospitals that are free to the poor. But when I got to the bottom of it I noticed that people were not getting the primary care they needed. Indians would rather treat themselves at home, with naturopathic or Aruvedic medicine or an antibiotic they picked up at a pharmacy without a prescription, than go to a doctor. With this pattern comes many late presentations of disease. This problem is sure to get worse with the increasing levels of diabetes, and this does not seem to be being addressed as of now.

Having soaked in the sites, sounds, smells, and tastes of a country as large and busy as India gives me a great perspective on the rest of the world. Almost 1/6th of the world’s people are on the subcontinent, and I have gained confidence after living how that huge chunk of the world lives. Like any time I leave the USA, I am reminded of the incredible luxuries that we have here. Potable water, roads that aren’t littered with garbage, potholes, cows, and unbelievably bad traffic, and decent access to health care. Also my freedom as a woman and as an American are something I take for granted. I was disappointed to see women not usually being treated as equals, and I constantly heard about the corruption of the government with attitudes of hopelessness to change. But I will never forget the kindness I and incredible selflessness I witnessed by my mentors, my hosts, and even strangers in India. Also there is great beauty in everything in India, from the temples, the delicious food, and the smells of jasmine and incense burning. This global health experience has enriched my education in medicine and human rights, and also personally enriched my life.

Transnational caregiving refers to the exchange of care and support across national boundaries.

This pilot project sought to examine transnational caregiving among Asian Indian elderly residing in India whose children resided outside India. A subgroup of Asian Indian elders whose children resided exclusively in India also participated in this study. This primarily helped define how similar or different the caregiving experience was based on whether children resided in India or outside India.

With the assistance of Silver Innings in Mumbai and Non‐Resident Indian Parents Association (NRIPA) in Bangalore, a total of 70 adults participated in this pilot project in Bangalore and Mumbai during 2010.http://www.blogger.com/img/blank.gifIndividuals participated in either a focus group meeting, completed a survey, or an extended phone interview to capture some of their transnational caregiving experiences.

Initial analysis of the findings suggests the following:1) Transnational caregiving involves reciprocal caregiving between Asian Indian adult children and parents. Such reciprocal caregiving also is evident among those whose children reside in India.

3) Caregiving by adult children includes frequent contact initiated to parents, periodic visits, emergency crisis care, and support during bereavement. In this group that largely represented an educated group of middle‐class or higher seniors, remittances made by adult children to parents were negligible.

4) Transnational caregiving is complex as it involves many challenges such as time, money, health,work schedules, marital status, travel costs, visa limitations, competing familial obligations, etc. Caregiving by children within India also involved many of the same challenges, except visa limitations and travel costs.

5) Communication technology has enhanced intergenerational contact as evidenced by the use of Skype, email, webcams, etc.

6) Majority of the senior participants whose children resided outside India were living independently in their own homes, were educated, middle‐income category or higher, socially active, enjoyed good health, and preferred to keep 'intimacy at a distance' with their children. They themselves were not keen to live in multi‐generation households.

7) Whether children resided in or outside India, it was clear that many of them lived in small‐sized households with or without their spouse. Paid help was frequently used to address some of the daily household tasks.

In today's global economy, despite the separation caused by national borders and geographic distance, a great deal of emotional support, communication, exchange, and caregiving takes place between adults and their elderly parents. Day to day dependence on adult children (whether they lived in India or outside India) appeared to be limited. As one participant said, "Whether our children live in Kengeri , Tumkur, or USA, it really makes no difference in everyday living."[The author gratefully acknowledges the generous assistance of Mr. M.R. Mahadevan (NRIPA, Bangalore) and Mr. Sailesh Mishra (Silver Innings, Mumbai) with the data collection process for this project]

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